Reduction of postoperative morbidity and mortality in patients with rectal cancer following the introduction of a colorectal unit

• Published in: British journal of surgery 2001-02, Vol.88 (2), p.273-277
• Main Authors: Smedh, K., Olsson, L., Johansson, H., Åberg, C., Andersson, M.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Analysis of Variance; Biological and medical sciences; Cancer Care Facilities - supply & distribution; Cancer Care Facilities - utilization; Denmark; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hospital Mortality; Hospital Units - supply & distribution; Hospital Units - utilization; Hospitals, District - supply & distribution; Hospitals, District - utilization; Humans; Length of Stay; Male; Medical sciences; Middle Aged; Postoperative Complications - prevention & control; Rectal Neoplasms - surgery; Retrospective Studies; Stomach, duodenum, intestine, rectum, anus; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Analysis; Treatment Outcome; Tumors
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1046/j.1365-2168.2001.01675.x

Background: Surgery for rectal cancer is associated with high morbidity and mortality rates. The reason for this has been much debated. This population‐based study reports the findings on postoperative morbidity and mortality after rectal cancer surgery following the introduction of a centralized colorectal unit in a county central hospital, supervised by a colorectal surgeon using the most recent techniques. Methods: All consecutive patients with rectal cancer who underwent surgery at four county hospitals in the Västmanland county in Sweden during 1993–1996 (n = 133) were compared with patients who underwent surgery at the new colorectal unit in the county central hospital from 1996 to 1999 (n = 144). Results: The number of operating surgeons was reduced from 26 to four. The postoperative mortality rate decreased from 8 to 1 per cent (P = 0·002) and the total postoperative complication rate was reduced from 57 to 24 per cent (P < 0·001). Surgical complications dropped from 37 to 11 per cent (P < 0·001). The relaparotomy rate fell from 11 to 4 per cent (P < 0·05). Postoperative stay in hospital was reduced from a median of 13 to 9 days (P < 0·001). Conclusion: The new organization, with centralized rectal cancer surgery using modern techniques, reduced postoperative mortality and overall morbidity rates to less than half. © 2001 British Journal of Surgery Society Ltd